| Fort Wingate Dental Clinic | |
|
520 B Shush Drive Exit 33 State Road 400 Ft . Wingate NM 87316 | |
| (505) 722-1770 | |
| (505) 722-1796 |
| Full Name | Fort Wingate Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 520 B Shush Drive, Ft . Wingate, New Mexico |
| Authorized Official Name and Position | Bennie C. Yazzie (ACTING CEO) |
| Authorized Official Contact | 5057221000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Wingate Dental Clinic 516 E. Nizhoni Blvd Gallup NM 87301-1337 Ph: (505) 722-1770 | Fort Wingate Dental Clinic 520 B Shush Drive Exit 33 State Road 400 Ft . Wingate NM 87316 Ph: (505) 722-1770 |
| NPI Number | 1952505208 |
|---|---|
| Provider Enumeration Date | 06/12/2007 |
| Last Update Date | 07/22/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952505208 | NPI | - | NPPES |
| 27603725 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 9435 (* (Not Available)) | Primary |